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Chronic kidney disease (CKD) is a global health challenge, with a reported prevalence of around 10%. Prescribing for patients receiving hemodialysis (HD) is challenging and complicated by polypharmacy, comorbidities, and changes in clearance of medications. The aim of this study was to evaluate antibiotics utilization patterns and dosage appropriateness in patients receiving HD at a tertiary hospital. A retrospective study was carried on 287 adult inpatients, who received HD and at least one antibiotic in a tertiary hospital in Oman. Data were extracted using the hospital's electronic patient information system. Dosage appropriateness was assessed by identifying the dosage and frequency of prescribed antibiotics and comparing them with international guidelines. The main outcome measures were antibiotics utilization patterns and dosing inappropriateness. The most commonly prescribed parenteral antibiotic was piperacillin + tazobactam (20%), while the most common prescribed oral antibiotic was azithromycin (41.7%). For prophylaxis, cefazolin (54.6%) was the main antibiotic prescribed. The most commonly used antibiotic for external use was mupirocin ointment (38.5%). The overall dosing inappropriateness was 29.5%. Vancomycin was the most common parenteral antibiotic subjected to dosing inappropriateness (19.8%). However, trimethoprim + sulfamethoxazole was more inappropriately prescribed among the oral route (28.6%). In conclusion, the most utilized antibiotic was piperacillin + tazobactam followed by vancomycin. The study reported some inappropriate dosing of antibiotics. Such a study opens the door for the establishment of local guidelines for the improved practice of antibiotics use in HD patients. [ABSTRACT FROM AUTHOR]

The severity and mortality from COVID-19 infection vary among populations. The aim of this study was to determine the prevalence and predictors of mortality among patients hospitalized with COVID-19 infection in a tertiary care hospital in Oman. We conducted a retrospective study using database that included: demographic, clinical characteristics, laboratory parameters, medications and clinical outcomes of all patients hospitalized in Royal Hospital, Muscat, Oman, between March 12, 2020 and December 1st 2020. Univariate and multivariate logistic regression was performed to investigate the relationship between each variable and the risk of death of COVID-19 infected patients. In total,1002 patients with COVID-19 infection with mean age of the cohort was 54 ± 16 years (65% (n = 650) male) were included, with an overall and intensive care unit (ICU) mortalities of 26% (n = 257) and 42% (n = 199/473), respectively. The prevalence of ICU admission was 47% (n = 473) and the need for mechanical ventilation was 41% (n = 413). The overall length of stay in the ICU was 13 (9–21) days. Adjusting for other factors in the model, the multivariable logistic regression demonstrated that in-hospital mortality in admitted COVID-19 patients was associated with old age (p < 0.001), heart diseases (adjusted odds ratio (aOR), 1.84; 95% confidence interval (CI): 1.11–3.03; p = 0.018), liver diseases (aOR, 4.48; 95% CI: 1.04–19.3; p = 0.044), those with higher ferritin levels (aOR, 1.00; 95% CI: 1.00–1.00; p = 0.006), acute respiratory distress syndrome (ARDS) (aOR, 3.20; 95% CI: 1.65–6.18; p = 0.001), sepsis (aOR, 1.77; 95% CI: 1.12–2.80; p = 0.022), and those that had ICU admission (aOR, 2.22; 95% CI: 1.12–4.38; p = 0.022). In this cohort, mortality in hospitalized COVID-19 patients was high and was associated with advanced age, heart diseases, liver disease, high ferritin, ARDS, sepsis and ICU admission. These high-risk groups should be prioritized for COVID-19 vaccinations. [ABSTRACT FROM AUTHOR]

• Anakinra averted the need for mechanical ventilation in patients with severe COVID-19 pneumonia. • Anakinra accelerated weaning off oxygen therapy and hastened transition to ambient air. • Patients treated with anakinra showed significant reduction in biomarkers of inflammation. • The study results did not demonstrate a significant difference in in-hospital mortality. • This study provided further evidence for the utility of anakinra in severe COVID-19 pneumonia. The aim of this study was to evaluate the efficacy of anakinra in patients who were admitted to hospital for severe COVID-19 pneumonia requiring oxygen therapy. A prospective, open-label, interventional study in adults hospitalized with severe COVID-19 pneumonia was conducted. Patients in the interventional arm received subcutaneous anakinra (100 mg twice daily for 3 days, followed by 100 mg daily for 7 days) in addition to standard treatment. Main outcomes were the need for mechanical ventilation and in-hospital death. Secondary outcomes included successful weaning from supplemental oxygen and change in inflammatory biomarkers. Outcomes were compared with those of historical controls who had received standard treatment and supportive care. A total of 69 patients were included: 45 treated with anakinra and 24 historical controls. A need for mechanical ventilation occurred in 14 (31%) of the anakinra-treated group and 18 (75%) of the historical cohort (p < 0.001). In-hospital death occurred in 13 (29%) of the anakinra-treated group and 11 (46%) of the historical cohort (p = 0.082). Successful weaning from supplemental oxygen to ambient air was attained in 25 (63%) of the anakinra-treated group compared with 6 (27%) of the historical cohort (p = 0.008). Patients who received anakinra showed a significant reduction in inflammatory biomarkers. In patients with severe COVID-19 pneumonia and high oxygen requirement, anakinra could represent an effective treatment option and may confer clinical benefit. ISRCTN74727214. [ABSTRACT FROM AUTHOR]

• Therapeutic plasma exchange (TPE) is associated with lower 28 days mortality and marginally associated with lower all-cause mortality. • The TPE group had higher extubation rates compared to the controls. • The TPE group was associated with improved laboratory and ventilatory parameters when compared to the control cohort. To evaluate the therapeutic use of plasma exchange in COVID-19 patients compared to controls. A case series of critically ill adult men and non-pregnant women, ≥18 years of age, with laboratory-confirmed COVID-19, was studied at the Royal Hospital, Oman, from April 17 to May 11, 2020. Therapeutic plasma exchange (TPE) was performed on patients admitted to the intensive care unit (ICU) with confirmed or imminent acute respiratory distress syndrome (ARDS) or severe pneumonia. The analysis was performed using univariate statistics. A total of 31 COVID-19 patients were included with an overall mean age of 51 ± 15 years (range: 27–76 years); 90% (n = 28) were males, and 35% (n = 11) of the patients had TPE as a mode of treatment. The TPE group was associated with higher extubation rates than the non-TPE cohort (73% versus 20%; p = 0.018). Additionally, patients on TPE had a lower 14 days (0 versus 35%; p = 0.033) and 28 days (0 versus 35%; p = 0.033) post plasma exchange mortality compared to patients not on TPE. However, all-cause mortality was only marginally lower in the TPE group compared to the non-TPE group (9.1% versus 45%; p = 0.055; power = 66%). Laboratory and ventilatory parameters also improved post TPE (n = 11). The use of TPE in severe COVID-19 patients has been associated with improved outcomes, however, randomized controlled clinical trials are warranted to draw final, conclusive findings. [ABSTRACT FROM AUTHOR]

• Almost half of meropenem orders were inappropriately prescribed. • Continuation of meropenem prescribing was justified, after culture and sensitivity, in just over half of the patients. • Meropenem doses were mostly appropriately prescribed in the majority of the patients. The aim of this study was to evaluate the use of meropenem in terms of indication and continuation of treatment at Sultan Qaboos University Hospital (SQUH), Muscat, Oman. A retrospective observational study, conducted by reviewing the medical records of 400 adults, admitted patients who received at least one dose of meropenem during the study period (January 2017 to September 2017). The analysis was performed using univariate statistics. Meropenem was prescribed empirically in 382/400 (96%) of the cases. The majority (315/361 (87%)) of the patients received the proper meropenem dose. The indication for meropenem was considered appropriate in only 196/400 (49%) of the cases. The continuation of treatment was evaluated according to culture and sensitivity results in 202 cases, out of which 112 (55%) were justified. Most of the inappropriate uses were seen in oncology and hematology cases (31/42 (74%) and 61/101 (60%), respectively) and among respiratory and urinary tract infections (126/155 (81%) and 40/46 (87%), respectively). Approximately half of the meropenem orders at SQUH in Oman were inappropriate and unjustified by culture-test results. New strategies are needed to optimize the rational use of meropenem and to ensure appropriate de-escalation and discontinuation of meropenem whenever indicated. [ABSTRACT FROM AUTHOR]

To identify the clinical characteristics and outcomes of hospitalized patients with COVID-19 in Oman. A case series of hospitalized COVID-19 laboratory-confirmed patients between February 24th through April 24th, 2020, from two hospitals in Oman. Analyses were performed using univariate statistics. The cohort included 63 patients with an overall mean age of 48 ± 16 years and 84% (n = 53) were males. A total of 38% (n = 24) of the hospitalized patients were admitted to intensive care unit (ICU). Fifty one percent (n = 32) of patients had at least one co-morbidity with diabetes mellitus (DM) (32%; n = 20) and hypertension (32%; n = 20) as the most common co-morbidities followed by chronic heart and renal diseases (12.8%; n = 8). The most common presenting symptoms at onset of illness were fever (84%; n = 53), cough (75%; n = 47) and shortness of breaths (59%; n = 37). All except two patients (97%; n = 61) were treated with either chloroquine or hydroxychloroquine, while the three most prescribed antibiotics were ceftriaxone (79%; n = 50), azithromycin (71%; n = 45), and the piperacillin/tazobactam combination (49%; n = 31). A total of 59% (n = 37), 49% (n = 31) and 24% (n = 15) of the patients were on lopinavir/ritonavir, interferons, or steroids, respectively. Mortality was documented in (8%; n = 5) of the patients while 68% (n = 43) of the study cohort recovered. Mortality was associated with those that were admitted to ICU (19% vs 0; p = 0.009), mechanically ventilated (31% vs 0; p = 0.001), had DM (20% vs 2.3%; p = 0.032), older (62 vs 47 years; p = 0.045), had high total bilirubin (43% vs 2.3%; p = 0.007) and those with high C-reactive protein (186 vs 90 mg/dL; p = 0.009) and low corrected calcium (15% vs 0%; p = 0.047). ICU admission, those on mechanical ventilation, the elderly, those with high total bilirubin and low corrected calcium were associated with high mortality in hospitalized COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: Medication errors occur frequently at transitions in care and can result in morbidity and mortality. Medication reconciliation is a recognized hospital accreditation requirement and designed to limit errors in transitions in care. Objectives: To identify beliefs, perceived roles and responsibilities of physicians, pharmacists and nurses prior to the implementation of a standardized medication reconciliation process. Methods: A survey was distributed to the three professions: pharmacists in the pharmacy and physicians and nurses in hospital in-patient units. It contained questions about the current level of medication reconciliation practices, as well as perceived roles and responsibilities of each profession when a standardized process is implemented. Value, barriers to implementing medication reconciliation and the role of information technology were also assessed. Analyses were performed using univariate statistics. Results: There was a lack of clarity of current medication reconciliation practices as well as lack of agreement between the three professions. Physicians and pharmacists considered their professions as the main providers while nurses considered physicians followed by themselves as the main providers with limited roles for pharmacists. The three professions recognize the values and benefits of medication reconciliation yet pharmacists, more than others, stated limited time to implement reconciliation is a major barrier. Obstacles such as unreliable sources of medication history, patient knowledge and lack of coordination and communication between the three professions were expressed. Conclusions: The three health care professions recognize the value of medication reconciliation and want to see it implemented in the hospital, yet there is a lack of agreement with regard to roles and responsibilities of each profession within the process. This needs to be addressed by the hospital administration to design clear procedures and defined roles for each profession within a standardized medication reconciliation process. [ABSTRACT FROM AUTHOR]

Background Atherogenic dyslipidemia is highly prevalent in the Arabian Gulf. Non–high-density lipoprotein cholesterol (non-HDL-C) reduction has been proposed as an additional goal to low-density lipoprotein cholesterol (LDL-C) lowering to prevent atherosclerotic cardiovascular disease (ASCVD). Data on non–HDL-C goal attainment in patients with high triglycerides (TGs) on lipid-lowering drugs (LLDs) in the region is scarce. Objective Evaluate non–HDL-C target attainment according to the National Lipid Association in patients on LLDs stratified by TG (<150 [1.69], 150–200 [1.69–2.26], >200 [2.26] mg/dL [mmol/L]) levels in the Arabian Gulf. Methods Overall, 4383 patients on LLD treatment from 6 Middle Eastern countries participating in the Centralized Pan-Middle East Survey on the Undertreatment of Hypercholesterolemia study were evaluated. Patients were classified according to TG levels and ASCVD risk. Results The overall non–HDL-C goal attainment was 41% of the subjects. Non–HDL-C goal was less likely attained in patients with high TGs (12% vs 27% vs 55%; P < .001). Very high ASCVD risk patients with high TGs attained less their non–HDL-C targets compared with those with lower TG levels (8% vs 23% vs 51%; P < .001). Similarly, high ASCVD risk patients with high TGs also failed more in attaining non–HDL-C targets compared with those with lower TGs (26% vs 42% vs 69%; P < .001). In addition, those with high TG also succeeded less in attaining LDL-C and apolipoprotein B goals ( P < .001). Conclusions A large proportion of very high and high ASCVD patients on LLDs in the Arabian Gulf are not at recommended non–HDL-C targets and hence remain at a substantial residual risk. [ABSTRACT FROM AUTHOR]

Aims To determine the status of blood sugar control by using fasting blood sugar (FBS) of ≤6.1 mmol/l and glycosyted hemoglobin A1c (HbAc1) of <7% as indictors of glycemic control and to assess the influence of demographic, blood pressure (BP) and lipid characteristics on glycemic control. Methods This retrospective study included all Omani patients with type 2 diabetes (N = 177) attended a primary health care center in Al-Dakhiliya region, Oman. Results The overall mean age of the cohort was 53 ± 12 years (range: 24-91) with females representing 60% (n = 106) of the study sample. The study found that only 9.6% (n = 17) and 35% (n = 62) of the patients attained optimal FBS and HbAc1 levels, respectively. Higher HbA1c was significantly associated with higher diastolic BP (84 versus 80 mm Hg; p = 0.006), higher total cholesterol (5.2 versus 4.7 mmol/l; p = 0.002) and higher low-density lipoprotein cholesterol (3.8 versus 3.0 mmol/l; p = 0.034). Conclusions The results demonstrated poor glycemic control in Oman type 2 diabetic patients comparable to local and global studies especially in those hypertensive and dyslipidemic patients. Implementation of early and aggressive management of diabetes mellitus at the primary care setting is warranted. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To evaluate the prevalence and predictors of microalbuminuria in type 2 diabetics in Oman. Methods: All patients attending an outpatient diabetic clinic at the Sultan Qaboos University Hospital between 2002 and 2003 were enrolled in the study. Results: A total of 261 patients were included in this study. The mean overall age of the cohort was 50±13 years, and 57% were male. The proportion of subjects who had microalbuminuria was 27% (n =70; N =261). The logistic regression model indicated that significant predictors for the development of microalbuminuria include HbA1c, log creatinine, and the presence of hypertension. A one unit increase in HbA1c was associated with a 23% increase in the odds of developing microalbuminuria (OR 1.23; 95% CI: 1.10–1.37; p <0.001). Additionally, patients that had a one unit increase in log creatinine were 5.72 times more likely to develop microalbuminuria (OR 5.72; 95% CI: 1.86–17.59; p =0.002). Furthermore, patients who were hypertensive were 2.37 times more likely to have microalbuminuria (OR 2.37; 95% CI: 1.11–5.09; p =0.026). Conclusions: The prevalence of microalbuminuria in patients with type 2 diabetes in this study was 27%. Significant predictors of microalbuminuria included HbA1c, creatinine, and the presence of hypertension. [Copyright &y& Elsevier]

The prevalence of multiple sclerosis (MS) has been changing not only globally but also in individual countries. We aim to estimate the prevalence of MS in the Omani population over the period from 2006-2019 as well as the incidence between 2015-2018. This is a retrospective observational hospital-based study. All MS patients diagnosed, as per the revised McDonald criteria, over the period from June 2006 and until May 2019, had their information reviewed for age at disease onset, gender and year of diagnosis. We obtained the population of Oman from the national census data. A total of 422 patients were diagnosed with MS during the study period and the population of Oman as per the 2019 census data was 2,652,199. The estimated crude prevalence was 15.9 (95% confidence interval: 14.4 - 17.5) per 100,000 and the female to male ratio was 2.17:1. The mean age at disease onset was 27.3 ± 7.7 (range: 9 - 59) years in which 83% of the patients had the first clinical manifestation at the age of 19 - 40 years, while only 9% had a disease onset at <19 years. The annual incidence increased from 1.00 case per 100,000 in 2015 to 1.38 cases per 100,000 in 2018. The prevalence of MS in the Omani population is 15.9 per 100,000 placing Oman as a medium risk zone. • Oman is a medium risk zone for multiple sclerosis as per Kurtzke. • Prevalence of multiple sclerosis in the Omani population is 15.9 per 100,000. • Annual incidence of multiple sclerosis in the Omani population is 1.38 cases per 100,000. • The mean age at multiple sclerosis onset in Omanis is 27.3 ± 7.7. [ABSTRACT FROM AUTHOR]

Background Information on the epidemiology of familial hypercholesterolemia (FH) in the Arabian Gulf region, which has an elevated rate of consanguinity and type II diabetes, is scarce. Objectives To assess the prevalence of FH, its management, and impact on atherosclerotic cardiovascular disease (ASCVD) outcomes in a multicenter cohort of Arabian Gulf patients with acute coronary syndrome (ACS). Methods Patients (N = 3224) hospitalized with ACS were studied. FH was diagnosed using the Dutch Lipid Clinic Network criteria. A composite endpoint of nonfatal myocardial infarction, stroke, transient ischemic attack, and mortality between the “probable/definite” and the “unlikely” FH patients was assessed after 1 year. Analyses were performed using univariate and multivariate statistical techniques. Results At admission, the proportion of “probable/definite”, “possible”, and “unlikely” FH in ACS patients was 3.7% (n = 119), 28% (n = 911), and 68% (n = 2194), respectively. Overall, 54% (n = 1730) of patients had diabetes, whereas 24% (n = 783) were current smokers. The “probable/definite” FH group was younger (50 vs 63 years; P < .001), had a greater prevalence of early coronary disease (38% vs 8.8%; P < .001), and previous statin use (87% vs 57%; P < .001) when compared with the “unlikely” FH group. After 1 year, the “probable/definite” FH cohort had worse lipid control (13% vs 23%; P < .001) and presented with a greater association with the composite ASCVD endpoint when compared with the “unlikely” FH group (odds ratio: 1.85; 95% confidence interval: 1.01–3.38; P = .047) after multivariable adjustment. Conclusions In Arabian Gulf citizens, FH was common in ACS patients, was undertreated, and was associated with a worse 1-year prognosis. [ABSTRACT FROM AUTHOR]

• Most interventions were significant and associated with improved efficacy. • Cost-saving of $200,000 USD/year was estimated as a result of the interventions. • Clinical pharmacists play a crucial role in antimicrobial stewardship. To evaluate the clinical and financial impact of clinical pharmacists' interventions (CPIs) on antimicrobial use at a 500-bed multidisciplinary tertiary care hospital in Oman. A retrospective analysis of CPIs related to antimicrobials use at Sultan Qaboos University Hospital (SQUH) from January to December 2018. Interventions were recorded using an electronic CPI form and were reviewed by two independent CPs. Data on the type and clinical significance of the interventions were extracted. Cost analysis was done using a previously defined cost avoidance model in addition to direct cost reduction estimation. Descriptive data were used to describe the results. In 2018, 26% of CPIs were related to antimicrobial use, with more than 60% of these interventions done on intensive care unit patients. The most common intervention type was adjusting the dosing regimen (42% of the total interventions), followed by deletion of the antimicrobial order in 34% of the cases. The most common clinical impact of CPIs was improving efficacy in 45% of the interventions, followed by preventing unnecessary exposure to the antimicrobials in around 30% of the interventions. The interventions were of major significance in 64% of the cases. This translated into a projected net cost saving of approximately $200,000 USD/year. CPs interventions on antimicrobial use had a positive impact on both the clinical and financial outcomes. [ABSTRACT FROM AUTHOR]

• Critical pertussis is associated with leukocytosis, especially white blood cell counts >31 × 109/L. • Patients with neutrophilia are at higher risk of critical pertussis. • Critical pertussis is associated with higher risk of bacterial infections. To identify risk factors and outcomes of patients with critical pertussis. Retrospective observational cohort study. Sultan Qaboos University Hospital and The Royal Hospital, Muscat, Oman. Children aged <13 years presenting to the emergency departments and diagnosed with laboratory-confirmed pertussis by polymerase chain reaction between January 2013 and December 2018. In total, 157 patients were diagnosed with pertussis, of which 12% (n = 19) had critical pertussis. Patients with critical pertussis had a higher white blood cell count (WBCC) [adjusted odds ratio (aOR) 1.05; 95% confidence interval (CI) 1.02–1.08; P = 0.003], absolute lymphocyte count (ALC) (aOR 1.08; 95% CI 1.03–1.15; P = 0.004) and absolute neutrophil count (ANC) (aOR 1.05; 95% CI 1.01–1.10; P = 0.032) than patients with non-critical pertussis, even after multi-variate adjustment. The area under the curve for discriminatory accuracy of laboratory variables was 0.75 (95% CI 0.65–0.85), 0.74 (95% CI 0.64–0.84) and 0.72 (95% CI 0.60–0.83) for maximum WBCC, ALC and ANC, respectively, with Youden's cut-off values of 31.5 × 109/L, 19.9 × 109/L and 5.0 × 109/L, respectively. In children, higher WBCC, ALC and ANC were significant predictors of critical pertussis. A cut-off level of 31.5 × 109/L for WBCC was associated with critical pertussis. [ABSTRACT FROM AUTHOR]

• Favipiravir and inhaled interferon compared with with hydroxychloroquine for moderate to severe COVID-19 pneumonia. • No difference between the 2 groups was found in time to recovary, inflammatory markers or improvement of oxygenation. • No differnece was found between the 2 groups in transfer to ICU or mortality. To evaluate the therapeutic effectiveness of favipiravir combined with inhaled interferon beta-1b in adult patients hospitalized with moderate to severe COVID-19 pneumonia. A randomized, open-label controlled trial of oral favipiravir in adults hospitalized with moderate to severe COVID-19 pneumonia from June 22nd 2020 to August 13th 2020 was conducted. Patients were randomly assigned to receive either a combination of favipiravir with interferon beta-1b by inhalation aerosol or hydroxychloroquine (HCQ). The outcome endpoints included improvement in inflammatory markers, lower length of hospital stay (LOS), discharges and lower overall 14-day mortality. A total of 89 patients underwent randomization with 49% (n = 44) assigned to favipiravir and 51% (n = 45) assigned HCQ. The overall mean age was 55 ± 14 years and 58% (n = 52) were males. There were no significant differences in the inflammatory biomarkers at hospital discharge between the two groups; C-reactive protein (p = 0.413), ferritin (p = 0.968), lactate dehydrogenase (p = 0.259) and interleukin 6 (p = 0.410). There were also no significant differences between the two groups with regards to the overall LOS (7 vs 7 days; p = 0.948), transfers to the ICU (18.2% vs 17.8%; p = 0.960), discharges (65.9% vs 68.9%; p = 0.764) and overall mortality (11.4% vs 13.3%; p = 0.778). No differences in clinical outcomes were found between favipiravir plus inhaled interferon beta-1b and hydroxychloroquine in adults hospitalized with moderate to severe COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

Summary: Objectives: To identify the clinical characteristics of outpatients with flu-like illnesses stratified by influenza A H1N1 status. Methods: The study was conducted at the H1N1 staff clinic of Sultan Qaboos University Hospital in Muscat, Oman. The population consisted of university students and university/hospital staff and their family members. All adult patients who presented to the H1N1 clinic with an influenza-like illness over a 4-month period (from August until the end of November 2009) were included. Real-time reverse transcriptase (rRT) PCR was used for the diagnosis of H1N1 influenza. Demographic data, clinical signs and symptoms, history of exposure to H1N1, history of recent travel, and co-morbid conditions were documented. Analyses were conducted using univariate and multivariate statistical techniques. Results: Out of the 2318 patients identified, 27% (n =616) were positive for H1N1 influenza. The mean temperature in the H1N1-positive group was significantly higher than in the negative group (38.3°C vs. 37.2°C; p <0.001). Proportions of patients who reported cough, sore throat, headache, myalgia, gastrointestinal symptoms, exposure to a confirmed case of H1N1, and a history of travel were significantly higher in the H1N1-positive group as compared to the swab-negative group. However, the multivariable logistic model identified only the following significant predictor variables of H1N1 infection: younger age, fever (≥37.8°C), sore throat, myalgia, diarrhea, and exposure to a confirmed H1N1 case within the last 7 days. Conclusions: This study provides useful data on the clinical characteristics of H1N1 influenza in a large outpatient population from the Middle East. Patients who tested positive for H1N1 were more likely to have fever, sore throat, diarrhea, and myalgia compared to those with other influenza-like illnesses. [Copyright &y& Elsevier]